| NPI | 1003556515 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207N00000X Dermatology (Licence: CA A191221) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MA 293781) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2022-03-31 |
| Last Update Date | 2024-04-12 |